B-2017-0361CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0361
19479 ROSEMARIE PL APT 2 CUPERTINO, CA 95014-3452 (375 01 007) HOMEOWNER
OWNER'S NAME; COHEN DAVID N AND WEISS CONSTANCE U ET AL
OWNER'S PHONE; 650-766-9160
LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor HOMEOWNER BUILDER Date
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
z. I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We) agree to save indemnify and keep harmless the
City of Cupertino against liabilities, judgments, costs, and expenses which
may accrue against said City. in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date 17
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
t. I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
-sale (Sec.7044, Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
3. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expqnses which may accrue against said City in
consequence of the gra9f6g of this permit. Additionally, the applicant understands
and will comply with a n -point source regulations per the Cupertino Municipal
Code, Section 9.18
Date 3/6/2017
DATE ISSUED: 03/06/2017
PHONE NO:
BUILDING PERNHT INFO:
X BLDG —ELECT _ PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
UNIT 2 - KITCHEN REMODEL (200 S.F.); BATHROOM REMODEL
(170 S.F.)
Sq. Ft Floor Area: Valuation: $7000.00
APN Number: Occupancy Type:
375 01 007
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Abby ygnd&
Date: 03/06/2017
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date:/3 6/2017
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cuperti cipal Code, Chapter 9.12 and
the Health & Safety Code, Se ons 505, 25533, and 25534.
Owner or authorized agent:
Date: 3/6/2017
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S
I understand my plans shall be used as public records.
Licensed
Professional
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE ® CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 s buildin cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION n ALTERATION / Ti ❑ RF.V1S10N / I-)FFFRRFI) ORTOWAI. PPRMIT 1i
PROJECT ADDRESS 19479 Rosemarie Pl, #',I _ L,upertino, CA
All 375-01-007
OWNERNAMECohen David N et al
FHGNE650-766-9160
7MAILdc94086@comcast.net
STREETADDRESS46O Fairfax Ave.
CITY, STATE, ZIP San Mateo, CA 94402
FAX
Robert Moore
"Robert
PHONE408a7-824'V-1116
E-M,4JL robert@losnessgroup.com
STREETADDRESS3131 S Bascom Ave., #230
CITY, STATE, ZIP Campbell, CA 95008
FAX
❑ OWNER ❑ OWNER -BUILDER 111 OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAMETim Heath
LICENSE NUMBER 863821
LICENSETYPEEleCt
BUS. LIC#
COMPANY NAME Star Lighting & Electric
E-MAILheath833@gmail.com
FAX
STREET ADDRESS 3860 Oakes Dr.
CITY, STATE, ZIP Hayward, CA 94542
PHONE (650) 787-7250
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
Bathrooms & Kitchens: Remove and replace existing cabinets, plumbing and electrical fixtures, and tile, like -for -like.
Z Under Contractor Star Lighting & Electric: Upgrade kitchen electrical to current code.
EXISTING USE
PROPOSED USE CONSTR.
T7
M= STORIES
USE71
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: LIDETACH
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNrr ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑NO
ADDITION? ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEI VW BY .. •
TOT,fVL _VAL 'I;IyON:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICTU R HOME? ® NO
}}
t►` °'-' -
By my signature below, I certify to each of the q ing: I am the property owner or authorized agent t act on tte property owner's behalf. I have read this
application and the information I have pro vid s correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to builds construct on. I authorize representatives of Cupertino to enter the abo elie tifed property for inspection purposes.
ApplicanUAgent:Date: Z
Signature of
--
SUPPLENWIRTAL INFORMATION UIRED
PLANT CHECK TYPE
ROUTING SLIP
171 0VMTHE-COUNTER
BCSnzrgGPLAN PXVMW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS:.
CI. PLANNIlWGPLANUEIVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
n STANDARD
rl P"LIC WORK$
form if any Hazardous Materials are being used as part of this project.
Q G.R
F1 nRF DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
MAJOR
D SANIT SEWER DISTRICT
submittal of Building Permit application.
ENVIRONMENTAL HEAL-
BldgApp_2011.doc revised 06/21/11
OWNER -BUILDER DISCLOSURE FORM
COPMVIUNITY DEVIL OPPMENT DEPARTww - BUILDUG DIVISION
(408) 777-3228- FAX
Dear Property Owner(s),
An application for a building.permit has 4eensubmitted in your nay-rie 11st'rig- V
. Q. t I - ourself as the buildler of the property
it specified at:
SFE ADDRESS 19479Rosemarie P1,Cupertif o,QA9501 N375-01-007
n
dl
OWNEAAAME CoOWNER ADDRESS
hen avid DN '. Cohen Thelma P
460 Fa'rfax Ave., San 'Mateo, CA 94402
Itchen rend-Witions and electriW panel upgrades on al'i 4 units of -our 4 -plea.
We are providing you with wq Owner-13pilder Acknowledgment and information Verifica4foriFdrin 16. rhake y
ou awa re of
your respQnsibili es and p -
PRI ossible risk you may incur by having this Permit issued in your name at the Owner Bultder. We
will not issue a building permit until you have read,nd
initialed -your understa . ing of each provision, signiad, and
returned this form to us at our official address indicated. An agent of the owner cannot execrate this notice unless
you, the property owner, obtain the pflo
. r approval of the permitting authority,
OWNER'S ACKN_0WLEQG1%1ENT AND-VERIF19CATTION 0
PUNFORMATION.
(DIRECIT10JUS. Please read iand h7ith4l each stat6mebt beldw to signify.you. understzmd or vedfy-thhinforn7afion)
�2YL_1-- I understand a frequent practice offunlicensed.personsJs to have the propefty Owner obtain an "Owner_
Builder" building. permit that erroneously implies that Die property own& is provid'
in bis or, he? own tab
oersonally. 1, as an Ovvner-Buildert may be held fiat 9 risk , - ot art, mal
le -arid subject to seribus financial for a inju i s sustained by
ny ne
an unlicerised.parsbri and his or her employees while w . ork;Ing rly. My homeown s r-ance p* not on my prope ee " sura in
provide coverage for those injuries, I amwillful ly acting as an
Oveer- Balder and am aware of the ljmitg of my
insffiY
urance coverage for injuries to worfeers, on my property.
I understand-buildin nits are not required tube signed -b property owners unless they are responsible for
g pe.ra
Zihoe-construction and are not hiring a licensed Contractor to assume this responsibility,
3- 1 understand as -an "'Ovvner-wilder"l am the responsible party of record on the permiLl understand that I- may
Protect myself from pottenti3l financial risk by hiring a licensed -Contractor and having the per grit filed In his or her
name instead of my ovvri,
-4--1 understand Contractors are required by law 40 be licensed and bonded in (aOidonnla and tPfist their license
. Off
numbers -on perrrilts and contracts.
understand, if I employ or other -wise engage any persons, other than California licensed Contractors, and the
total vaIL16 of my construction is at least five hundred dollars .($500), including labor and materials, I rriay be
considered an 'employee' L! rider state and federal km.
,Bpi undiarMand if 1 am considered an "employer' -under state and federal law, I mu regi;terwith: the state and
teder . I govern.ment.withhold payroll'taxes.disabilityst reRl
a provide workers' iinsurance,. arid contribute to
unemployment compensation for each `ernployee." I also understand my failure to aWda by these.lawrs Maysubject
me to serious. financial risk.
VTA understand.under California Contractors' -State License Law, an. Owner -Builder who builds sing16-family
rdsFdf_nfial structures hribt legally Wild them with the:intent to offer them flit sale,,' unieqs all work is performed by
licensed subcontractors and the number of structures does not exceed.fato within any calendar year, car all of the work
is performed under contract with a licensed general building Contractor.
*understand as an Ownar-E3uilder if I sell the property for
� which th s permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s) that result from any latent coinstruction.
defects In the workmanship or materials,
ChmorguilderForw2010 &x mwszd 04;74/10
I understand I may obtain more inform
ationregarding my obligations as an "Omplclyee� from the Intema!
Revenue Service, the Uhited States Small Busineis Administration, the California Department6fBenefit Payments,
and the Califorrila DI-Asion. of Industrial Accidents, 1 also understand I mayconta Contractor
contact the Cadifi, 'Ornia s, state
License Board:(C-8LB; at 1-800-321-GSLB (2
752) or w1rWx_slb.ca.gov for mote information 4406t]Ic6rised
contractors.
I am aware of and consent to anOwner- -Builder building permit applied for in my name and understatid-that I
Bu r
am the party legally and WarWMIY responsible for proposed cons "the, site 8ddress list Ob V
trubtion ac ivity at ed o e-
-1 agree that'. as the party legally and'Onancially responsible for this.Proposeed consfructiOn activfty, I will abide
by all applicable lags and requirements that govern Qcaner-Builders as well as employers.
j : f agree to notify the issuer of this forrn immediately of any additions, deletions, orthanges to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed W - prbtect the public. If
you contract with someone who does not have a
oe license, the Q)ntractors' :,Rtate License
Board may be unqbl� to
assist you With any financial lost YOU.MaV sustain -as: a result -of A compiainL You, on ly rem4d sed
ice
.yagain stunk-ris
Contractors may be in civil court. It isalso'.irnpOrtant for you to understandthat if an' unlicensed Contradfor or
employee of thatindividual QrArm is injured while working on your property hable for da ages. If
you may be held M
you obtain a permit as Owher:-Builder and wish to hire Con:tractors,
you 1�Vli
1be responsible tforvee`mg whether or not
those Contractors are, properly licensed and the status of their workers' compensation Insurance cove.rage-
CONSTRUCTION LENDING AGENCY
(DIRECTIONS: Plaase cotnpiate thefoijowing construoti_n lending agel I 7CV informatiork-)
I hereby affirm that there is a constritetion Jeiidipg agency for the perforrnanc-&of the work for wis
hich this permit i issued
(Ser, 3097 Civ.) v
Lender Name-,
Lender Address,
Before a crtidsrferr dan' be
xe Issued, this fbrM Milst bb Cpl eted-arid signedb theprope
Y rty Owner and
Oeturned to the agency respposible for Iss iNate., A copy of the prop own&'s driver#cOnsa_,:
uJing the pprmi Orty
tb= notarization. or,other verification sccypt may be required to be presented issaai
presented , 0, nen the permit
veaffiv the a'tp'lfe�
Property Ownei's Signature:
agent of the property owner to apply for 6 construction permit for the
Date:
Excluding the Notice to Property Owner, the, execution of Which I understand is my personal r6spOnsibility, I hereby
authorize the fallowing per-son(s)tri act.astiny agerit(s.)'to applyfear,sign, and filethe 0ocurnents nems-sarytooblain art
darter- udder Permit for my proi ec.t.
- * . Kitchen renovations and electrical Panel u
Scope of Construction Project (or Deso6ption oWO
f W. pg
Project Location or Address 19
.479- Rosemarie P1, Cupertino, -CA 95014
..... .. . ..
Name of AuthorizedAg ent.- Robert V Moore
fetN6408-82-4-1.1 - 16
Address of Authorized Ag nt- 1131 BascomAv 42
..30,CamPbe11,CA95008
I declare under penalty cif.perjury that Larn 'the property owner for the address listed above and I personally filled out the
above Information and certify its accuracy. Note: A copy -of the property owner's driver's ticense, form notarization, I or other
verification acceptoble to the citypjay b %r -err t �e, presented when the. permit is issued to verify the property owneil's
signature.
Propet, Ownw*s signature "., il. Date'
O,w�w)Bvdderftm 2010.doc revised 041r!4/10
Assessor's Parcel Number: 00
/T
Name of Owner: li� rAi D.9 Orli I V
/1
F i rl E
Contact Person: ko r 1nI I 2,-� r ocore
phone: 409 — Op 2 Lr ^ D ,
Project Address: ( q y� C) .�n a ril e 4"
1 a C—f
1
Scope of Work: i�rot �rs ',fd1��s,S,
p
Kpk,,
r
Code Editions: 2013 California Residential Code
r^
2013 California Plumbing Code
C'r rG of
2013 California Mechanical Code
2013 California Electrical Code
2013 California Energy Code
Enerov Code mandatory Ilohenn measures:
1. All permanently Installed high efficacy luminaires shall be switched separately from low efficacy lumimires.(150(k)(7))
2. Permanently Installed lighting in Kitchens shall be high efficacy luminaires. Up to 50% Of the wattage of permanently installed lighting In kitchens may be in lights that
are not high efficacy. (150(k)(8))
(,"4�r-aornS
rt•. Sf�!�t..-
Elumb'na Notes -
1. Faucets in kitchens, wet bars, lavatories, laundry sinks, etc shall have a water flow not to exceed 1.8 gallons per minute Q 60 psi. (CPC 403.6)
Electrical Notes: -
2. Then bd1a0on of smoke -alarms in all of the following areas shall be provided: (R3t4.3)
a. On the telling or well outside of each separate sleeplrg area in the immediate vicinity of bedrooms.
b. In each room used for sleeping purposes.
c. In each story within a dwelling unit, Including basements but not Including cmwl spaces and uninhabitable aftp s.
3. Approved carbon monoxide alarms shall be Metalled outside of each separate sleeping area in the Immedia+.e vicinity of the bedmoms and on every level including
basements in dwelling units that have fuel -fired appliances or attached garages. (CRC R315.1)
4. A minimum of two 20 amp small appliance branch circuits shall be provided for all receptacle outlets In the kitchen, dining room, pantry, or other similar areas. (CEC
210.11(0)(1))
6. At least ore 20 amp branch circuit shall be provided to supply batramore moeplacle outlets. Such circuits shall have no other oullets- (CEC 210.11(CX3)).
6. In every dwelling unit, fixed appliances such as food waste grinders, dishwashers, washing machines, dryers, laundry tray locations, buill-in refrigerators or freezers,
furnaces, AC units, built-in heaters or any other fixed appliance with a motor of h.p. or larger shall be on a separate 20 amp, branch cimuit
7. All receptedes in bathrooms, garages, accessory buildings, outdoors, creed spaces, unfinished basements, kitchens (where receptacles serve counter top surfaces)•
laundry, utility, wet bar sinks (within 6 feet of the edge of the sink)• shall have ground -fault circuit Interrupter (GFCI) protecfion. (C EG 210.8(A))
8. In all areas specified In 210.52, all non-locking type 126-v.1, 15- and 20- ampere receptacles shall be listed tamper-resistant receptacles. (CEC 406.12)
COMi'IUNITYC ',,ELOP,.IFN'EEPART.VENIT
BUILDING DWISION - (W`.:2TIN0
APPROVED
This set of plan; ;3eci(icatiens AI'_IST be kept at the
IC0 Site durin; C'f :rJCtien Its ll"' :'.f,l t0 make an
changes Or &it r ,ions on s:n��i., or to deviate
tr.ere'rom, .Groan)
TCF j(3rl in -. „ frac. ;i. . y Official.
9 '.. o.and5 e SHALL 140T
be held to pe-rr•il t.)bean ,,t, , ;,,': of the violater,
ya•s;,, , any Ordinance er State Laef.
of any pB Y _ (,�
DATE- 3
PER%IIT # l
`f
�-7UPFRTINp
M���?017
A n0 Depaft ent
lvevlewea B} -,fUt_ ODMPL(AIVCE
I *'
JOB COPY
THIS PLAN SHALL REMAIN ON
EXISTING KITCHEN FLOOR PLAN THE d0B ALL TIMES DURING PROPOSED KITCHEN FLOOR PLAN
CONSTRUCCTION
ovvko-.J C
do Y t
1
C'r rG of
(,"4�r-aornS
rt•. Sf�!�t..-
Elumb'na Notes -
1. Faucets in kitchens, wet bars, lavatories, laundry sinks, etc shall have a water flow not to exceed 1.8 gallons per minute Q 60 psi. (CPC 403.6)
Electrical Notes: -
2. Then bd1a0on of smoke -alarms in all of the following areas shall be provided: (R3t4.3)
a. On the telling or well outside of each separate sleeplrg area in the immediate vicinity of bedrooms.
b. In each room used for sleeping purposes.
c. In each story within a dwelling unit, Including basements but not Including cmwl spaces and uninhabitable aftp s.
3. Approved carbon monoxide alarms shall be Metalled outside of each separate sleeping area in the Immedia+.e vicinity of the bedmoms and on every level including
basements in dwelling units that have fuel -fired appliances or attached garages. (CRC R315.1)
4. A minimum of two 20 amp small appliance branch circuits shall be provided for all receptacle outlets In the kitchen, dining room, pantry, or other similar areas. (CEC
210.11(0)(1))
6. At least ore 20 amp branch circuit shall be provided to supply batramore moeplacle outlets. Such circuits shall have no other oullets- (CEC 210.11(CX3)).
6. In every dwelling unit, fixed appliances such as food waste grinders, dishwashers, washing machines, dryers, laundry tray locations, buill-in refrigerators or freezers,
furnaces, AC units, built-in heaters or any other fixed appliance with a motor of h.p. or larger shall be on a separate 20 amp, branch cimuit
7. All receptedes in bathrooms, garages, accessory buildings, outdoors, creed spaces, unfinished basements, kitchens (where receptacles serve counter top surfaces)•
laundry, utility, wet bar sinks (within 6 feet of the edge of the sink)• shall have ground -fault circuit Interrupter (GFCI) protecfion. (C EG 210.8(A))
8. In all areas specified In 210.52, all non-locking type 126-v.1, 15- and 20- ampere receptacles shall be listed tamper-resistant receptacles. (CEC 406.12)
COMi'IUNITYC ',,ELOP,.IFN'EEPART.VENIT
BUILDING DWISION - (W`.:2TIN0
APPROVED
This set of plan; ;3eci(icatiens AI'_IST be kept at the
IC0 Site durin; C'f :rJCtien Its ll"' :'.f,l t0 make an
changes Or &it r ,ions on s:n��i., or to deviate
tr.ere'rom, .Groan)
TCF j(3rl in -. „ frac. ;i. . y Official.
9 '.. o.and5 e SHALL 140T
be held to pe-rr•il t.)bean ,,t, , ;,,': of the violater,
ya•s;,, , any Ordinance er State Laef.
of any pB Y _ (,�
DATE- 3
PER%IIT # l
`f
�-7UPFRTINp
M���?017
A n0 Depaft ent
lvevlewea B} -,fUt_ ODMPL(AIVCE
I *'
JOB COPY
THIS PLAN SHALL REMAIN ON
EXISTING KITCHEN FLOOR PLAN THE d0B ALL TIMES DURING PROPOSED KITCHEN FLOOR PLAN
CONSTRUCCTION